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Indiana Petition for Change of Name of Minor Petition for Change of Name of Minor
Petitioner(s) makes (make) the following declaration:
1. Birth Date and Place: The minor was born on _______________________, 20____ in ________________________ [city], ________________________ [county], ________________________ [state]. A certified copy of the minor's birth certificate is attached to this petition.
2. Birth Name: The minor was named
____________________________________________ at birth, and as of the date of
this petition, the minor has always been known by that name, with the
following exceptions, if any:
3. Residence: The minor resides at _____________________________________________________________________________ [insert the minor's residential address] and has lived at this address for ________ [insert length of time in months or years at this address]. The Petitioner(s) resides (reside) at _____________________________________________________________________________ [insert residential address] and has (have) lived at this address for ________ [insert length of time in months or years at this address].
4. Minor's Parents: The father of the minor is named ______________________________________________, and he resides at _____________________________________________________________________________ [insert residential address of father]. The mother of the minor is named ______________________________________________, and she resides at _____________________________________________________________________________ [insert residential address of mother].
5. Reason for Name Change: Petitioner(s) seeks (seek) to change
name to ______________________________________________ and offers (offer) the following reason(s) for seeking to do so:
6. Legal and Creditor Status: The minor does not have any outstanding judgments, has never been convicted of a crime, and is not involved in any pending legal actions.
7. Additional Declarations: In addition to the foregoing
statements, the Petitioner(s) further declares (declare):
NOW, THEREFORE, the Petitioner(s) requests (request) that the court order the minor's name changed as follows:
(Note: The grey box below is not a part of the Petition and is included for informational purposes only. You should not include the grey box as part of this document.)
Consent to Change of Name of Minor
I make the following declaration:
1. Name: My name is
____________________________________________, and as of the date of
the signing of this Consent, I have always been known by that name, with the
following exceptions, if any:
2. Residence: I reside at _____________________________________________________________________________ [insert the residential address] and have lived at this address for ________ [insert length of time in months or years at this address].
3. Consent to Change of Name of Minor: I am fully informed of the legal consequences and effects, and I give my consent to the request of the Petitioner(s) to change the name of said minor child as follows:
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